Notes from Communication-a-thon Meeting 2010-08-17
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Notes from Communications Workgroup
Date: August 17, 2010
Time: 9:30am-12:00pm
Attendees:
Rich Elmore, Jason Siegel, Joel Ryba, G. Denrick Reichard, Michele Darnell, Brian Ahier, David Kibbe, Uvinie Hettiaratchy, Caitlin Ryan
Actions from this Week
Rich Elmore
· Looking at Communications Plan and Matrix:
o Left hand column of State HIEs and RECs: lots of activities within those groups, influential in their market so it is key for them to understand NHIN Direct.
o Next, Healthcare delivery systems: high priority for early communication, Sept/Oct in terms of timeframe for execution.
o Vendors: high priority because of participation in NHIN Direct pilots, need technology enablement (HISPs, healthcare providers), practical use by various healthcare stakeholders.
o Finally, a glance to other priority one user stories from NHIN Direct. There are policy considerations about the patient and education of the patient, and the WG can have a degree of influence in this category.
· Overall, WG believes State HIEs have a high degree of influence, while healthcare delivery systems and RECs have medium/low influence on NHIN Direct participation.
Jason Siegel
· Question: Just talking about NHIN Direct or more broadly? What is the scope of this WG?
Rich Elmore
· WG is meeting the needs for NHIN Direct communication to outside of NHIN Direct. Yes, there have been other connectivity approaches. So WG needs to establish really what is NHIN Direct, what is the value of NHIN Direct?
· Example, HIEs may worry about NHIN Direct because they fear it cuts them out as middle man.
Uvinie Hettiaratchy
· Points out that the communications matrix posted on the wiki is a draft. She has material for the incomplete areas on the matrix such as how the project affects the group, but she intended to not include it here. She doesn’t want her pre-work to tailor the direction the group goes. She wants WG members to edit the material and run with it.
· àAs a takeaway, let’s go through, edit matrix individually to see what we can add. When this is clear we have a better idea of what can be communicated.
Rich Elmore
· These matrix profiles will help the WG come back to the major questions we are trying to answer.
· People can be assigned to each of the categories to help lead WG through a conversation about how it affects the group, working from the top down.
· Asks Brian Ahier to walk WG through HIEs, RECs.
Brian Ahier
· Edited HIE and RECs segment directly on the wiki.
· Looking from a standpoint of exchange capabilities for stage one of Meaningful Use (MU), question has been raised, what is NHIN Direct going to do for HIE as they develop their own plans?
· Find gaps in coverage, along with RECs and providers to adopt MU.
· As far as initial exchange capability, the same type of messaging could be used for RECs as they assist the client site. As David pointed out in CT, RECs involved in implementation geographies and HIEs should also be encouraged to be involved.
· Concerns he is hearing: how does NHIN fit within meaningful use? How does it fit within NHIN Exchange? All these questions need answers and targeted messaging to states and RECs.
· Reaching out to small practices, clinical access hospitals, will be very important as well.
· Likes idea of following the money. Vendors/providers are all looking at MU, so they want to identify the minimal standards they need to meet to be eligible for MU.
Rich Elmore
· What are the concerns the states have around NHIN Direct and how can those be addressed?
Brian Ahier
· A good explanation can be found in the NHIN Direct Overview document. Rather than a long document with all user stories, the overview document is concise.
· Yet he thinks there should be a one-page document or brochure. This would also be helpful for the vendors. It would identify NHIN Direct approved products, compliant with the guidelines so vendors can determine if their product allows for use of NHIN Direct. Also they can incorporate NHIN Direct into their planning.
Jason Siegel
· Agrees. When his bosses ask him for summaries, they want executive summaries, bulleted text goes over better than paragraphs. Then these summaries move up the chain. So they can come to the conclusion that both “we need to implement this” and “why?”.
Rich Elmore
· Right, it needs to be clear that NHIN Direct is about secure point to point messaging between stakeholders. The content of the message could be anything.
Jason Siegel
· Public health had a secure messaging system, different from this. It was different, but was national at the same time. CDC has a standard for state public health agencies to communicate disease notifications. It involves passwords, a wrapper, etc.
· So we have to make sure that we consider any other national standards already implemented and what our relationship is to those already existing. Michele Darnell
· Comment from a state: “this NHIN Direct stuff is going to screw up what we are trying to do with our HIE. It is a distraction from the repository we are trying to create.”
· States are concerned about the future, and NHIN Direct is perceived as not necessarily positive. Most are concerned about adoption and accelerating smaller providers to be able to exchange.
· Question: why is it important to at least provide this step, and how can it accelerate current initiatives for the better, and not serve as a distraction?Brian Ahier · Part of messaging needs to be what NHIN Direct is NOT. Talking about spending for HIE, WG must note services you can layer on top that NHIN Direct does not provide, such as a master patient index. We’re talking about simple services and protocols that will enable state HIEs to fill the gaps, but will not supplant the higher level HIE services.
David Kibbe
· Good point. Turning negatives into positives.
· Need to think about how we feel in this competitive park. For instance, some physicians don’t like the HIEs. They don’t want to be locked in. Not sure we can solve that problem, but should have a nuanced message to HIEs such as, “we think you can take advantage of NHIN Direct protocols to offer larger group of people baseline productivity to be able to provide things simple transport cannot do. Have you thought about the negative reactions to your approach? Has anyone complained they don’t want to be forced into your network?”
Rich Elmore
· Seems like a potential way to address that issue. First, highlight the positives for the states in adopting NHIN Direct. Then, deal with the negative aspect for HIEs of providers avoiding lock-ins to further attract those HIEs to NHIN Direct because NHIN Direct can be used alongside additional services.
· Defining HISP: A HISP is a defined term for NHIN Direct, and it means routing from point A to point B, part of the fabric of NHIN Direct that handles routing, facilitates point to point exchange.
Jason Siegel
· Asks about wider regional or non-state HIEs.
Joel Ryba
· Need to be careful about WG’s definition of HIEs. In some cases it is an internal system, in others it is an outside vendor. HIE can be broad. There are differences between the community, governing bodies and other ad hoc bodies. Also some vendors consider themselves HIEs.
David Kibbe
· Need to recognize this is a rapidly transforming area. HIEs were first created to address problem of interoperability. Standards are moving quickly, with M&As indicative of the changes within health exchange operability.
· WG should give up on the notion that HIE means one thing.
Joel Ryba
· So WG is discussing state designated exchanges, not private exchanges (health care delivery network, for example).
· If WG is discussing both, message should be different for each.
Jason Siegel
· Vendor neutral?
Joel Ryba
· Uses patient-centric records where 1:1 exchange is conducted through secure messaging. NHIN Direct protocols should keep patient centricity because need to do other exchanges not part of initial 1:1 transaction, but need info from the transaction. For example, lab result goes through HIE, but a prescription is issued for the patient based on the lab result. The HIE needs to maintain patient centricity. Can use NHIN Direct protocols to do that, will allow us to send messages across jurisdictional borders. A lot of good can be done with protocols within rules of a state’s designated exchange. Could do point to point messages every day. If someone’s means of receiving a lab report is an NHIN Direct message instead of an HL7 message, the system is perfectly fine with that type of transaction. They can decrypt at HIE and incorporate into records.
Rich Elmore
· Moving on to healthcare delivery systems.
David Kibbe
· Presents messaging profile for Individual Providers.
· Was thinking from prospective of small/medium medical practices and how to describe to them the benefits and uses of NHIN Direct.
· First, what is NHIN Direct? They need to understand at a basic level what it is. His basic definition is: ”secured email for physicians, colleagues, and patients” rather than “protocols/policies/standards.”
· We will also interact with physicians who have other parts of the EHR systems; some have full-blown electronic health records but may not include ability to do MU.
· The four main benefits to individual providers :
o ease of use,
o replaces hassle of fax,
o helps meet Meaningful Use criteria regulations,
o and freedom to choose its own way of achieving MU through certified technology without paying lots of upfront costs, or over committing to particular brand.
Rich Elmore
· Wants to know more about freedom to choose.
David Kibbe
· There is an array of EHR technology that is compliant with MU, but for individual providers to be able to keep NHIN Direct address while they move between software products doesn’t lock them in to any particular software.
· Some vendors might be hesitant, but others get it, “if we are providing NHIN Direct to our client, we can also provide to non-clients and they may become clients later on.”
· If one of very valuable component for physicians becomes messaging with patients and colleagues through NHIN Direct, that encourages adoption because physicians don’t have to worry they will need to buy a new NHIN Direct product.
Jason Siegel
· One concern, WG must be very clear that we know who the intended audience is.
· From the provider perspective, we need to be specific about which stage of MU is met. So if I’m a provider wondering how I fit my 2011 requirements, how soon do I need to act? What is our counter message in terms of “yes you do need to use NHIN Direct” if provider asks a vendor and they say they already meeting MU and do not need additional services?
David Kibbe
· MU Stage One core requirement is to give a clinical summary to all patients who request within 48 hours. Many cannot do this now.
· They also have to demonstrate the exchange of clinical data.
Jason Siegel
· Where does it say you can’t just send an email? Why does it have to be secure?
Joel Ryba
· Agrees that addressing the question “is implementing NHIN Direct really necessary?” would be good.
· In short, if consumers and data providers can already transform data into messages and get it back out of the HIE, NHIN Direct is just one of those potential forms for transport of the message.
· Providers might buy into NHIN Direct to avoid EMR upgrade.
Rich Elmore
· WG should be careful to not overstate NHIN Direct’s capabilities. It may facilitate the transfer of data but not be the only path.
Brian Ahier
· One of the things he doesn’t see yet in communications WG plans is engaging associations and stakeholder groups of individual providers, Association of American Physicians, for example.
David Kibbe
· AFP has been really involved, agrees WG should extend involvement to other organizations.
Rich Elmore
· Would messaging to them be similar to messaging for individual providers? Would there be a different twist?
David Kibbe
· A different twist is needed. The core of the message needs to be how the organization can become a source for good info about NHIN Direct. How do we help AMA, etc. feel confident that whatever is on their website, in their web portals, in their meetings, is accurate and is seen as beneficial to their members? These organizations care about being of value to their members. Messaging along those lines works.
· WG should add in some subtly in terms of specialties versus primary care. Sending and returning a message is different for a primary care physician than it is for a cardiologist.
Michele Darnell
· Earlier someone mentioned “why can’t I just email?” as a question this WG might face. What we have seen in both primary care and specialist environments is that there is still a lot of misinformation about email and secure portals. On the “individual providers” page we can replace cost of fax machine point with the question of “why can’t I just email?” Some folks are still just emailing. Not everyone has the right info.
· WG should identify and correct misinformation.
· Two, mapping out MU components for what is required is very important.
Joel Ryba
· NHIN Direct should send presenters, participants to meetings of those organizations.
Rich Elmore
· Next priority segment: healthcare delivery systems and providers.
David Kibbe
· Just to make sure we are on the same page, HDS primarily talks about hospitals and communities of affiliated physician groups, agreed?
All
· Yes.
David Kibbe
· Thinks all hospitals in the country that have medical groups that they own and affiliated medical practices around them, whether large or very small, are facing a problem of connectivity in a big way.
· They are desperately trying to figure out how to replace fax machines, lab results, how they can provide EHR technology to the practices they own but also provide pathways (money, help) so affiliated health practices can also communicate with hospital systems.
· In marketplace he sees connectivity, interoperability, productivity drive from the hospital system in conjunction with their affiliates (the vendors?).
· Hospital systems have a strong interest in becoming HISPs, offering basic services. In this they require NHIN Direct to begin to connect at a basic transport layer at a low operating cost, reasonably low implementation cost, often replacing courier services, fax, paper, electronic fax.
· There are probably 3 to 4 other messages, but this is at the core. Need to get into the face of the CIO and offer NHIN Direct as part of a solution for connectivity. Note that NHIN Direct can be implemented along with more complicated system as a way to reach out to group of local physicians they want to be able to communicate with at low cost and high efficiency.
· Following the money is important. CWG should place MU connectivity summary in NHIN Direct message.
Joel Ryba
· Lab results are important to consider.
Michele Darnell
· Affiliated and non-affiliated, right?
David Kibbe
· Yes, depends on where they are starting from.
Rich Elmore
· Next, vendors. Janet Campbell produced the following (wiki: “Vendor Profile”, [1]).
· What are the things vendors will be interested in? Cost, benefit, etc.
· First, what does it take for a vendor to implement NHIN Direct?
o 1) NHIN Direct workflow requirements that have been delegated to the EHR
o 2) Technologies where supporting code libraries have been developed (.NET and Java)
o 3) Can find many ways to utilize existing product capabilities. Vendors need to be comfortable with what can be reused with NHIN Direct. How can they take this to the next level?
§ Can tie in with documentation WG work.
· Next is the benefit point of view: why should vendors support NHIN Direct?
o Our sense is that there will be high usage, so vendors will follow if users are turning to NHIN Direct.
o Thinks this opens up connectivity to 700,000 providers in the US. Large adoption, flexible ability to reach anyone in healthcare.
Joel Ryba
· Need to say NHIN Direct is directly under ONC. Also, is being NHIN Direct compliant a MU requirement? Is there a certification process we can promise?
Rich Elmore
· No certification through NHIN Direct.
Joel Ryba
· People have the impression that NHIN Direct standards offer MU certification. WG needs to clarify that it isn’t the case or imply that it is so that people jump on board.
Rich Elmore
· WG cannot imply NHIN Direct certifies MU requirements are met, but can help vendors meet those MU marks.
· Without making an absolute statement, WG can say that NHIN Direct help facilitates meeting MU requirements.
· Can use an inside-out approach for vendors, making sure they understand what the measurements are for success.
· From the vendor perspective: Need a call for action, what do we want them to do?
o Participate in pilots.
o Develop how to communicate to clients.
Joel Ryba
· What about specialist EMRs like labs and the messaging for products specific only to EMRs?
· Can get more vendors involved.
Rich Elmore
· Intent: HIT vendors, not just EMR.
Joel Ryba
· Most providers are small providers and have simpler systems. My company is in 42 states and does parts of systems that are actively looking at certification. There are vendors like us just doing immunization, for example. Public health clinics need to be inclusive of HIT.
· Some other group may be covering this, but this WG can help promote.
· NHIN Direct should have a test site. If a system wants to test and validate, there should be a way for them to do so. The CDC has a system like this. You can send a message, and then it can be validated that you sent correctly. This is easy to implement because then the testing doesn’t have to put together resources for someone to receive it.
Rich Elmore
· àMoving influence of vendors to a high priority, because communicating to them was already a high priority.
Brian Ahier
· Good idea.
Michele Darnell
· Clarification: this group is talking about all HIT vendors?
All
· Yes.
Michele Darnell
· A comment on general messaging: there is a whole world of other exchange around health plans, involving exchange through clearinghouses.
· Provider community and all vendors are going to be communicating in this method as well. That side is also getting into critical information exchange.
· They often want to connect with their providers in one method. It would be important for that part of the community to understand what is being adopted on the NHIN Direct side, too.
David Kibbe
· Should consider HIT EHR technology for hospitals in addition to the primary care environment.
· Interests in health delivery network, but the two camps are divided. WG should think about a strategy that works on both sides, with appropriate nuances for each.
· Should reach out to other IT vendors who are non EHR but want to become players in the EHR field.
G. Denrick Reichard
· As an EHR provider vendor, thinks it is nice to try to entice people through marketing but what really gets attention are the teeth behind the certification process. CCHIT is a “four letter word” in some circles but has been his small company’s mantra.
· Interoperable capabilities need to support overall NHIN directive, to seamlessly move forward without posing additional development costs.
· From the vendors’ perspective the big thing to point out is that you will satisfy some component of MU by developing these [NHIN Direct] standards.
Rich Elmore
· So we got through the profiles. We do still need to get to our messaging. But today’s great commentary will drive us forward.
· Next steps: being able to start on foundational messaging work.
o àNEXT MEETING IS TUES
o What is NHIN Direct generally? How about across the stakeholders?
§ àSee Overview, we want to boil down into essential elements
§ àReview segments
Volunteers for extracting out what the key messages are for all priority stakeholders?
David Kibbe
· àCan work with someone to come up with 5-6 priority messages in the priority order?
Rich Elmore
· Agrees that is the goal. We want to consistently get messages out.
Jason Siegel
· àCan contribute but cannot commit to lots of time yet.
Volunteers for priority segment messaging?
Brian Ahier
· àWill take State HIEs and RECs, begin to refine
David Kibbe
· àWill do healthcare delivery systems.
Michele Darnell
· àWill work on vendors.
· Clarifying: looking for top 5-6 messages?
Rich Elmore
· Idea here is to boil it down.
· Look at what David did in individual section as a model. May address fears and concerns or “follow the money” points. Priority order is good. Actual number is less important. Try to get that key list down so we know what to include in our messaging on a consistent basis.
Jason Siegel
· àCould be a bounce back person, as a vendor himself.
Rich Elmore
· àTarget deadline for all work is Monday. Should be ready for WG’s Tuesday meeting.
Rich Elmore
· Appreciates diverse perspectives within the WG.
· àWill prepare something for the larger NHIN Direct group tomorrow.
Date: August 17, 2010
Time: 9:30am-12:00pm
Attendees:
Rich Elmore, Jason Siegel, Joel Ryba, G. Denrick Reichard, Michele Darnell, Brian Ahier, David Kibbe, Uvinie Hettiaratchy, Caitlin Ryan
Actions from this Week
| # |
Date |
Action |
Status |
Owner |
Due Date |
| 3 |
8/17/10 |
Develop key messaging for All Stakeholders |
Open |
David Kibbe, Rich Elmore, Jason Siegel (assist) |
8/23/10 |
| 4 |
8/17/10 |
Develop key messaging for HIEs and RECs |
Open |
Brian Ahier |
8/23/10 |
| 5 |
8/17/10 |
Develop key messaging for Healthcare Delivery Systems/Providers |
Open |
David Kibbe |
8/23/10 |
| 6 |
8/17/10 |
Develop key messaging for Vendors |
Open |
Michele Darnell, Jason Siegel (assist) |
8/23/10 |
| 7 |
8/17/10 |
Review NHIN Direct Overview Document, attempt to boil down into essential elements. |
Open |
WG |
8/23/10 |
| 8 |
8/17/10 |
Review segments in the matrix, make necessary changes. |
Open |
WG |
8/23/10 |
Actions from last Week
| # |
Date |
Action |
Status |
Owner |
Due Date |
| 1 |
08/10/10 |
Draft profiles for assigned audience by Face to Face meeting |
Closed |
WG |
8/16/10 |
| 2 |
08/10/10 |
Post initial communications matrix to the wiki for review by WG during Face to Face |
Closed |
Uvinie Hettiaratchy |
8/16/10 |
Agenda (for not just the day’s meeting, but the communications WG overall)
- Communications Plan and Matrix
- Segment Analyses (see links in the Communications Plan and Matrix)
- What is NHIN Direct? For reference, see NHIN Direct Overview
- Segment Messaging
- Channel and Vehicle Analysis
- Communications Deliverables
- Responsibility Analysis
- Execute and Iterate
Notes
Rich Elmore
· Last week the workgroup (WG) focused on identifying various stakeholder groups and determining messages for stakeholder groups.
· Based on the defined segments the WG is conducting segment analysis to define needs/concerns/messages for each segment.
Jason Siegel
· Thinks it is important that WG communicates what NHIN Direct is relative to everything people have already heard of up to this point. If they’ve heard of past standardization attempts, WG needs to let them know where NHIN Direct fits. Where do others fit? Is this the master integrator or a pilot project that can be ignored?
· It appears to the outsider that NHIN Direct is a set of requirements coming directly from ONC, HHS, so the stakeholder groups who been misinformed need to be set straight.
Rich Elmore
· For today, looking at what WG wants to emphasize in individual messaging for particular stakeholders.
· A strong communications plan includes channels and stakeholders, and will allow WG to kick off the work of creating the right communications vehicle.
· Need action items to create communications deliverable to get message out to intended audiences.
· As NHIN Direct progresses there will be evolving needs from the communications WG, as Jason Siegel said, right now the WG is at a different level in terms of the purpose of messaging. Now messaging should support the NHIN Direct pilot programs, then later on support general adoption of NHIN Direct.
· WG can leverage skills and knowledge of other implementation groups.
Round the Room: Any questions?
| Jason Siegel |
Glad the communications WG has been created. Sees a strong need for connecting providers. Joel Ryba Asks Jason if he sees the HIE Connect series as already connecting physicians. Jason Siegel As a physician himself, recognizes there are many events that happen every year, but feels those other events are different. They touch on the same things, like interoperable healthcare, but the challenge is getting someone actually providing healthcare to get a sense of how it all comes together. Need a message for approaching the average provider. Can ask,”Have you heard of the HIE connect-a-thon?” Yes. “Do you know about NHIN Direct?” No. “Interested in something like NHIN Direct?” Yes. So far there has not been enough emphasis on the outliers and people who are not already engaging in those annual events. NHIN Direct needs more buy-in. |
| G. Denrick Reichard |
No comment. |
| Joel Ryba |
Interested in the work, sees some of the needs assessment as the pre-work that should have been done before embarking on the technical side of developing the NHIN Direct product, while only a small portion of communication is outreach that happens after there is already a product. If we are going to create a product, what is the market for it? How many involved have a marketing background? Need SMEs to help us. |
| Jason Siegel |
There are a few people at Atlas participating in different ways. Michelle Del Guercio of Atlas has marketing experience. |
| Brian Ahier |
No comment. |
| Michele Darnell |
No comment now. |
Rich Elmore
· Looking at Communications Plan and Matrix:
o Left hand column of State HIEs and RECs: lots of activities within those groups, influential in their market so it is key for them to understand NHIN Direct.
o Next, Healthcare delivery systems: high priority for early communication, Sept/Oct in terms of timeframe for execution.
o Vendors: high priority because of participation in NHIN Direct pilots, need technology enablement (HISPs, healthcare providers), practical use by various healthcare stakeholders.
o Finally, a glance to other priority one user stories from NHIN Direct. There are policy considerations about the patient and education of the patient, and the WG can have a degree of influence in this category.
· Overall, WG believes State HIEs have a high degree of influence, while healthcare delivery systems and RECs have medium/low influence on NHIN Direct participation.
Jason Siegel
· Question: Just talking about NHIN Direct or more broadly? What is the scope of this WG?
Rich Elmore
· WG is meeting the needs for NHIN Direct communication to outside of NHIN Direct. Yes, there have been other connectivity approaches. So WG needs to establish really what is NHIN Direct, what is the value of NHIN Direct?
· Example, HIEs may worry about NHIN Direct because they fear it cuts them out as middle man.
Uvinie Hettiaratchy
· Points out that the communications matrix posted on the wiki is a draft. She has material for the incomplete areas on the matrix such as how the project affects the group, but she intended to not include it here. She doesn’t want her pre-work to tailor the direction the group goes. She wants WG members to edit the material and run with it.
· àAs a takeaway, let’s go through, edit matrix individually to see what we can add. When this is clear we have a better idea of what can be communicated.
Rich Elmore
· These matrix profiles will help the WG come back to the major questions we are trying to answer.
· People can be assigned to each of the categories to help lead WG through a conversation about how it affects the group, working from the top down.
· Asks Brian Ahier to walk WG through HIEs, RECs.
Brian Ahier
· Edited HIE and RECs segment directly on the wiki.
· Looking from a standpoint of exchange capabilities for stage one of Meaningful Use (MU), question has been raised, what is NHIN Direct going to do for HIE as they develop their own plans?
· Find gaps in coverage, along with RECs and providers to adopt MU.
· As far as initial exchange capability, the same type of messaging could be used for RECs as they assist the client site. As David pointed out in CT, RECs involved in implementation geographies and HIEs should also be encouraged to be involved.
· Concerns he is hearing: how does NHIN fit within meaningful use? How does it fit within NHIN Exchange? All these questions need answers and targeted messaging to states and RECs.
· Reaching out to small practices, clinical access hospitals, will be very important as well.
· Likes idea of following the money. Vendors/providers are all looking at MU, so they want to identify the minimal standards they need to meet to be eligible for MU.
Rich Elmore
· What are the concerns the states have around NHIN Direct and how can those be addressed?
Brian Ahier
· A good explanation can be found in the NHIN Direct Overview document. Rather than a long document with all user stories, the overview document is concise.
· Yet he thinks there should be a one-page document or brochure. This would also be helpful for the vendors. It would identify NHIN Direct approved products, compliant with the guidelines so vendors can determine if their product allows for use of NHIN Direct. Also they can incorporate NHIN Direct into their planning.
Jason Siegel
· Agrees. When his bosses ask him for summaries, they want executive summaries, bulleted text goes over better than paragraphs. Then these summaries move up the chain. So they can come to the conclusion that both “we need to implement this” and “why?”.
Rich Elmore
· Right, it needs to be clear that NHIN Direct is about secure point to point messaging between stakeholders. The content of the message could be anything.
Jason Siegel
· Public health had a secure messaging system, different from this. It was different, but was national at the same time. CDC has a standard for state public health agencies to communicate disease notifications. It involves passwords, a wrapper, etc.
· So we have to make sure that we consider any other national standards already implemented and what our relationship is to those already existing. Michele Darnell
· Comment from a state: “this NHIN Direct stuff is going to screw up what we are trying to do with our HIE. It is a distraction from the repository we are trying to create.”
· States are concerned about the future, and NHIN Direct is perceived as not necessarily positive. Most are concerned about adoption and accelerating smaller providers to be able to exchange.
· Question: why is it important to at least provide this step, and how can it accelerate current initiatives for the better, and not serve as a distraction?Brian Ahier · Part of messaging needs to be what NHIN Direct is NOT. Talking about spending for HIE, WG must note services you can layer on top that NHIN Direct does not provide, such as a master patient index. We’re talking about simple services and protocols that will enable state HIEs to fill the gaps, but will not supplant the higher level HIE services.
David Kibbe
· Good point. Turning negatives into positives.
· Need to think about how we feel in this competitive park. For instance, some physicians don’t like the HIEs. They don’t want to be locked in. Not sure we can solve that problem, but should have a nuanced message to HIEs such as, “we think you can take advantage of NHIN Direct protocols to offer larger group of people baseline productivity to be able to provide things simple transport cannot do. Have you thought about the negative reactions to your approach? Has anyone complained they don’t want to be forced into your network?”
Rich Elmore
· Seems like a potential way to address that issue. First, highlight the positives for the states in adopting NHIN Direct. Then, deal with the negative aspect for HIEs of providers avoiding lock-ins to further attract those HIEs to NHIN Direct because NHIN Direct can be used alongside additional services.
· Defining HISP: A HISP is a defined term for NHIN Direct, and it means routing from point A to point B, part of the fabric of NHIN Direct that handles routing, facilitates point to point exchange.
Jason Siegel
· Asks about wider regional or non-state HIEs.
Joel Ryba
· Need to be careful about WG’s definition of HIEs. In some cases it is an internal system, in others it is an outside vendor. HIE can be broad. There are differences between the community, governing bodies and other ad hoc bodies. Also some vendors consider themselves HIEs.
David Kibbe
· Need to recognize this is a rapidly transforming area. HIEs were first created to address problem of interoperability. Standards are moving quickly, with M&As indicative of the changes within health exchange operability.
· WG should give up on the notion that HIE means one thing.
Joel Ryba
· So WG is discussing state designated exchanges, not private exchanges (health care delivery network, for example).
· If WG is discussing both, message should be different for each.
Jason Siegel
· Vendor neutral?
Joel Ryba
· Uses patient-centric records where 1:1 exchange is conducted through secure messaging. NHIN Direct protocols should keep patient centricity because need to do other exchanges not part of initial 1:1 transaction, but need info from the transaction. For example, lab result goes through HIE, but a prescription is issued for the patient based on the lab result. The HIE needs to maintain patient centricity. Can use NHIN Direct protocols to do that, will allow us to send messages across jurisdictional borders. A lot of good can be done with protocols within rules of a state’s designated exchange. Could do point to point messages every day. If someone’s means of receiving a lab report is an NHIN Direct message instead of an HL7 message, the system is perfectly fine with that type of transaction. They can decrypt at HIE and incorporate into records.
Rich Elmore
· Moving on to healthcare delivery systems.
David Kibbe
· Presents messaging profile for Individual Providers.
· Was thinking from prospective of small/medium medical practices and how to describe to them the benefits and uses of NHIN Direct.
· First, what is NHIN Direct? They need to understand at a basic level what it is. His basic definition is: ”secured email for physicians, colleagues, and patients” rather than “protocols/policies/standards.”
· We will also interact with physicians who have other parts of the EHR systems; some have full-blown electronic health records but may not include ability to do MU.
· The four main benefits to individual providers :
o ease of use,
o replaces hassle of fax,
o helps meet Meaningful Use criteria regulations,
o and freedom to choose its own way of achieving MU through certified technology without paying lots of upfront costs, or over committing to particular brand.
Rich Elmore
· Wants to know more about freedom to choose.
David Kibbe
· There is an array of EHR technology that is compliant with MU, but for individual providers to be able to keep NHIN Direct address while they move between software products doesn’t lock them in to any particular software.
· Some vendors might be hesitant, but others get it, “if we are providing NHIN Direct to our client, we can also provide to non-clients and they may become clients later on.”
· If one of very valuable component for physicians becomes messaging with patients and colleagues through NHIN Direct, that encourages adoption because physicians don’t have to worry they will need to buy a new NHIN Direct product.
Jason Siegel
· One concern, WG must be very clear that we know who the intended audience is.
· From the provider perspective, we need to be specific about which stage of MU is met. So if I’m a provider wondering how I fit my 2011 requirements, how soon do I need to act? What is our counter message in terms of “yes you do need to use NHIN Direct” if provider asks a vendor and they say they already meeting MU and do not need additional services?
David Kibbe
· MU Stage One core requirement is to give a clinical summary to all patients who request within 48 hours. Many cannot do this now.
· They also have to demonstrate the exchange of clinical data.
Jason Siegel
· Where does it say you can’t just send an email? Why does it have to be secure?
Joel Ryba
· Agrees that addressing the question “is implementing NHIN Direct really necessary?” would be good.
· In short, if consumers and data providers can already transform data into messages and get it back out of the HIE, NHIN Direct is just one of those potential forms for transport of the message.
· Providers might buy into NHIN Direct to avoid EMR upgrade.
Rich Elmore
· WG should be careful to not overstate NHIN Direct’s capabilities. It may facilitate the transfer of data but not be the only path.
Brian Ahier
· One of the things he doesn’t see yet in communications WG plans is engaging associations and stakeholder groups of individual providers, Association of American Physicians, for example.
David Kibbe
· AFP has been really involved, agrees WG should extend involvement to other organizations.
Rich Elmore
· Would messaging to them be similar to messaging for individual providers? Would there be a different twist?
David Kibbe
· A different twist is needed. The core of the message needs to be how the organization can become a source for good info about NHIN Direct. How do we help AMA, etc. feel confident that whatever is on their website, in their web portals, in their meetings, is accurate and is seen as beneficial to their members? These organizations care about being of value to their members. Messaging along those lines works.
· WG should add in some subtly in terms of specialties versus primary care. Sending and returning a message is different for a primary care physician than it is for a cardiologist.
Michele Darnell
· Earlier someone mentioned “why can’t I just email?” as a question this WG might face. What we have seen in both primary care and specialist environments is that there is still a lot of misinformation about email and secure portals. On the “individual providers” page we can replace cost of fax machine point with the question of “why can’t I just email?” Some folks are still just emailing. Not everyone has the right info.
· WG should identify and correct misinformation.
· Two, mapping out MU components for what is required is very important.
Joel Ryba
· NHIN Direct should send presenters, participants to meetings of those organizations.
Rich Elmore
· Next priority segment: healthcare delivery systems and providers.
David Kibbe
· Just to make sure we are on the same page, HDS primarily talks about hospitals and communities of affiliated physician groups, agreed?
All
· Yes.
David Kibbe
· Thinks all hospitals in the country that have medical groups that they own and affiliated medical practices around them, whether large or very small, are facing a problem of connectivity in a big way.
· They are desperately trying to figure out how to replace fax machines, lab results, how they can provide EHR technology to the practices they own but also provide pathways (money, help) so affiliated health practices can also communicate with hospital systems.
· In marketplace he sees connectivity, interoperability, productivity drive from the hospital system in conjunction with their affiliates (the vendors?).
· Hospital systems have a strong interest in becoming HISPs, offering basic services. In this they require NHIN Direct to begin to connect at a basic transport layer at a low operating cost, reasonably low implementation cost, often replacing courier services, fax, paper, electronic fax.
· There are probably 3 to 4 other messages, but this is at the core. Need to get into the face of the CIO and offer NHIN Direct as part of a solution for connectivity. Note that NHIN Direct can be implemented along with more complicated system as a way to reach out to group of local physicians they want to be able to communicate with at low cost and high efficiency.
· Following the money is important. CWG should place MU connectivity summary in NHIN Direct message.
Joel Ryba
· Lab results are important to consider.
Michele Darnell
· Affiliated and non-affiliated, right?
David Kibbe
· Yes, depends on where they are starting from.
Rich Elmore
· Next, vendors. Janet Campbell produced the following (wiki: “Vendor Profile”, [1]).
· What are the things vendors will be interested in? Cost, benefit, etc.
· First, what does it take for a vendor to implement NHIN Direct?
o 1) NHIN Direct workflow requirements that have been delegated to the EHR
o 2) Technologies where supporting code libraries have been developed (.NET and Java)
o 3) Can find many ways to utilize existing product capabilities. Vendors need to be comfortable with what can be reused with NHIN Direct. How can they take this to the next level?
§ Can tie in with documentation WG work.
· Next is the benefit point of view: why should vendors support NHIN Direct?
o Our sense is that there will be high usage, so vendors will follow if users are turning to NHIN Direct.
o Thinks this opens up connectivity to 700,000 providers in the US. Large adoption, flexible ability to reach anyone in healthcare.
Joel Ryba
· Need to say NHIN Direct is directly under ONC. Also, is being NHIN Direct compliant a MU requirement? Is there a certification process we can promise?
Rich Elmore
· No certification through NHIN Direct.
Joel Ryba
· People have the impression that NHIN Direct standards offer MU certification. WG needs to clarify that it isn’t the case or imply that it is so that people jump on board.
Rich Elmore
· WG cannot imply NHIN Direct certifies MU requirements are met, but can help vendors meet those MU marks.
· Without making an absolute statement, WG can say that NHIN Direct help facilitates meeting MU requirements.
· Can use an inside-out approach for vendors, making sure they understand what the measurements are for success.
· From the vendor perspective: Need a call for action, what do we want them to do?
o Participate in pilots.
o Develop how to communicate to clients.
Joel Ryba
· What about specialist EMRs like labs and the messaging for products specific only to EMRs?
· Can get more vendors involved.
Rich Elmore
· Intent: HIT vendors, not just EMR.
Joel Ryba
· Most providers are small providers and have simpler systems. My company is in 42 states and does parts of systems that are actively looking at certification. There are vendors like us just doing immunization, for example. Public health clinics need to be inclusive of HIT.
· Some other group may be covering this, but this WG can help promote.
· NHIN Direct should have a test site. If a system wants to test and validate, there should be a way for them to do so. The CDC has a system like this. You can send a message, and then it can be validated that you sent correctly. This is easy to implement because then the testing doesn’t have to put together resources for someone to receive it.
Rich Elmore
· àMoving influence of vendors to a high priority, because communicating to them was already a high priority.
Brian Ahier
· Good idea.
Michele Darnell
· Clarification: this group is talking about all HIT vendors?
All
· Yes.
Michele Darnell
· A comment on general messaging: there is a whole world of other exchange around health plans, involving exchange through clearinghouses.
· Provider community and all vendors are going to be communicating in this method as well. That side is also getting into critical information exchange.
· They often want to connect with their providers in one method. It would be important for that part of the community to understand what is being adopted on the NHIN Direct side, too.
David Kibbe
· Should consider HIT EHR technology for hospitals in addition to the primary care environment.
· Interests in health delivery network, but the two camps are divided. WG should think about a strategy that works on both sides, with appropriate nuances for each.
· Should reach out to other IT vendors who are non EHR but want to become players in the EHR field.
G. Denrick Reichard
· As an EHR provider vendor, thinks it is nice to try to entice people through marketing but what really gets attention are the teeth behind the certification process. CCHIT is a “four letter word” in some circles but has been his small company’s mantra.
· Interoperable capabilities need to support overall NHIN directive, to seamlessly move forward without posing additional development costs.
· From the vendors’ perspective the big thing to point out is that you will satisfy some component of MU by developing these [NHIN Direct] standards.
Rich Elmore
· So we got through the profiles. We do still need to get to our messaging. But today’s great commentary will drive us forward.
· Next steps: being able to start on foundational messaging work.
o àNEXT MEETING IS TUES
o What is NHIN Direct generally? How about across the stakeholders?
§ àSee Overview, we want to boil down into essential elements
§ àReview segments
Volunteers for extracting out what the key messages are for all priority stakeholders?
David Kibbe
· àCan work with someone to come up with 5-6 priority messages in the priority order?
Rich Elmore
· Agrees that is the goal. We want to consistently get messages out.
Jason Siegel
· àCan contribute but cannot commit to lots of time yet.
Volunteers for priority segment messaging?
Brian Ahier
· àWill take State HIEs and RECs, begin to refine
David Kibbe
· àWill do healthcare delivery systems.
Michele Darnell
· àWill work on vendors.
· Clarifying: looking for top 5-6 messages?
Rich Elmore
· Idea here is to boil it down.
· Look at what David did in individual section as a model. May address fears and concerns or “follow the money” points. Priority order is good. Actual number is less important. Try to get that key list down so we know what to include in our messaging on a consistent basis.
Jason Siegel
· àCould be a bounce back person, as a vendor himself.
Rich Elmore
· àTarget deadline for all work is Monday. Should be ready for WG’s Tuesday meeting.
Rich Elmore
· Appreciates diverse perspectives within the WG.
· àWill prepare something for the larger NHIN Direct group tomorrow.